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The objective of this study was to analyze aspects related to interprofessional education in healthcare through the assessment of the syllabi of undergraduate nursing programs in Brazil. An observational, descriptive study was conducted in two phases. The first phase involved identification of programs, and the second phase involved documental analysis of the syllabi through a script created for this purpose. One thousand two hundred and twenty nursing undergraduate programs were identified; 229 were included in the sample for the document analysis. In 2.6% of the programs, the term "interprofessional" was identified in the purpose of the programs. Seventeen percent of the programs valued interprofessional education, and 8% assessed interprofessional learning. Recognizing (9.2%) and respecting (6.6%) the attributes and roles of different professionals were the least identified interprofessional values in the syllabi. Interprofessional education was not institutionalized/stated in the documents, even though the documents indicated use of interprofessional relationships in training scenarios, especially in primary care, and in activities not included in the formal curriculum.
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Bacharelado em Enfermagem , Educação em Enfermagem , Estudantes de Enfermagem , Humanos , Brasil , Relações Interprofissionais , CurrículoRESUMO
OBJECTIVE: Analysing the concepts of Continuous Health Education - CHE (EPS - in Portuguese), operated by municipal managers and translated into official documents. METHOD: Qualitative research with the use of official documents and semi-structured interviews with the Municipal Health Secretaries or Coordinators of Primary Health Care in the Northeast Region of São Paulo State, and thematic analysis of empirical material. RESULTS: Results indicate difficulties in the municipalities problematizing their management practices, services and health care; EPS tools presented are insufficient and unsatisfactory for amending the array of problems raised and are still far from the routine of Primary Care services. CONCLUSION: Despite efforts to implement EPS actions for the strengthening of primary care, the process appears to be incipient.
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Educação Continuada , Atenção Primária à Saúde , Brasil , Educação em SaúdeRESUMO
OBJECTIVE: Analyzing the conceptions of supervision of nurses in the Family Health Strategy (ESF - Estratégia Saúde da Família) in relation to community health workers (ACS - Agente Comunitário de Saúde), taking for reference the work process and the power relations. METHOD: A qualitative study, in which 18 interviews were carried out with nurses from the ESF in the countryside of the state of Goiás. Following transcription, the data were subjected to thematic content analysis and the following categories were identified: Supervision with that sees it all and Supervision is participating and working together. RESULTS: Among the findings, it is clear the character of control and monitoring that is carried out primarily through printed instruments and home visits, which constitute vertical and impositive relations, and suffer influence of the local health management. Another finding is the supervision as acting together and with the educational perspective. CONCLUSION: The supervision carried out does not provide the changes intended by the ESF.
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Agentes Comunitários de Saúde , Saúde da Família , Supervisão de Enfermagem , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto JovemRESUMO
The objective of this study was to analyze the use of relationship technology in care provided to patients with arterial hypertension. This is a qualitative study, conducted in eight Family Health Units from Jequié-Bahia. The study subjects were policy makers, health professionals and patients, totaling sixteen informants. Semi-structured interviews, systematic observation and documental analysis were performed in 2012. The data were submitted to thematic content analysis. Results showed that the professionals, especially nurses and community health workers, use light technology in the search for comprehensive care. On the other hand, some professionals have demonstrated biology-based practice, with emphasis on rules and procedures. It is concluded that there is a need to change professional-patient interactions, considering the uniqueness and autonomy of the patient and family in the construction of new forms of care.
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Tecnologia Biomédica , Hipertensão/terapia , Atenção à Saúde/normas , HumanosRESUMO
This qualitative research aimed to analyze the view of the workers at a basic health unit on the presence of nursing students at the service. Eighteen workers participated in semi-structured interviews, analyzed after transcription. In the content analysis, we identified two themes: The slowing and quickening of service and The (un) preparedness to learn and teach. The results point to a process of teaching-service partnership still under construction, in which workers feel as though they are learning, but also feel devalued. The presence of the students changes the work dynamics, slowing it. At the same time, the presence of the students questions the hegemonic ways of rapid assistance. An expectation of collaboration in actions is evidenced, there being a preference for students in the last years of undergraduate courses, who perform procedures and do not require constant accompanying. We conclude that the approach between university and primary healthcare services exposes tensions which, collectively analyzed, can engender new ways of caring, teaching and learning.
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Atitude do Pessoal de Saúde , Educação em Enfermagem/métodos , Atenção Primária à Saúde , Estudantes de Enfermagem , Pesquisa QualitativaRESUMO
The literature in the field of health management mentions a concept called new public management (NPM), introduced in Brazil and France at the end of the 20th century. The objective of the study was to analyze the repercussions of the work of nurses in primary health care in Brazil and France under the influence of NPM. This is an excerpt of a double-titled thesis, which is a research intervention with nurses from two Brazilian states and five French departments. Data were produced between February 2019 and July 2021. The public policy Health on the Hour acted as an institutional transducer, provoking a reduction in access and producing effects on professional practices. In both countries, NPM amplified the predominance of technical and quantifiable acts, the focus on individual care, and the loss of autonomy. Nurses reported insurmountable situations, using the metaphor "Sophie's choice". The results showed that making dilemmatic decisions has been the daily routine of nurses, which has not resulted in debureaucratization and higher quality of care.
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The objective of this intervention study was to map instituted and instituting movements present in the work of the Family Health Strategy in the development of their care practices. The theoretical framework is based on institutional analysis, using the schizoanalytic approach. Group meetings were carried out with the staff to discuss how they provided collective care in continuing health education. The study subjects were professionals from the team and students who were engaged in academic activity in the service. The average attendance was twelve people per meeting, and there were a total of eight meetings from March to July 2010. Data were grouped into two immanent strata: the relationships of the team and the relationship with clients. The strata point to the intersection of education and legal institutions and the social and technical division of labor. Collective thinking in groups appeared to be effective in denaturalizing established processes and interrogating places, knowledge and practices.
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Saúde da Família , Processos Grupais , Pessoal de Saúde , Equipe de Assistência ao Paciente , Brasil , HumanosRESUMO
OBJECTIVE: to analyze the resistance to interprofessional collaboration in the professional practices of residents in primary health care. METHOD: Social and clinical qualitative research with 32 residents of a Multiprofessional Residency, carried out from 2017 to 2018. Data production included Institutional Analysis of Professional Practices, document analysis; investigator's diary; and observation. Data were analyzed based on Institutional Analysis concepts. RESULTS: There were contradictions between the reproduction of uniprofessional education with a focus on the specialty and interprofessional collaborative practices. The resistance analysis pointed to two axes: not-knowing as an analyzer of resistance to collaboration; interprofessional interference and knowledge-power relations. Residents' practices were characterized as resistant to interprofessional collaboration. CONCLUSION: The resistance analysis in the Multiprofessional Residency showed integrative movements of assimilation and disputes with physician-centered power, with damage to the sharing of care and interprofessional communication. The collective analysis questioned health professionals education, revisiting the perspective of comprehensive care guided by the users' needs.
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Internato e Residência , Médicos , Comportamento Cooperativo , Humanos , Relações Interprofissionais , Equipe de Assistência ao Paciente , Atenção Primária à Saúde , Pesquisa QualitativaRESUMO
This article comprises the authors' reflections about theory and experiences about the connection between research, teaching and health care services for the consolidation of the Brazilian National Health System (SUS - Sistema Único de Saúde). The research in collective health nursing face the challenge of breaking with the traditional forms that separate those who research, teach, learn and provide care. The movement for changing the process of caring and teaching occurs through an investigative and reflexive production. Therefore, the studies for the consolidation of the SUS call for an intense connection between teaching-service and knowledge production. It challenges us to create research projects together with the workers, which implies advancing the data collection to data production, and taking students to the activities and internship for the alliance and co-responsibilization of actions. We propose assuming the lack of knowledge to create instituting practices.
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Programas Governamentais , Pesquisa , Brasil , Atenção à Saúde , Humanos , Internato e Residência , Atenção Primária à SaúdeRESUMO
This exploratory-descriptive study was performed using a qualitative approach with the purpose to identify and analyze the attributes mobilized in work situations that characterize the performance of nurses in managerial competence in Family Health based on the concepts of dialogic competence. Data collection was performed through participant observation of the work performed by Family Health nurses in four units associated with the University of São Paulo in Ribeirão Preto - SP/Brazil, considering a typical workweek, with a total of 160 hours of observation. Through content analysis, using the thematic analysis technique, we identified five themes related to: supervision, teamwork, social control, work organization and planning. Results show there is a group of attributes mobilized by nurses which remains centered on work organization for individual health care with rare incursions for a systemized planning process.
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Saúde da Família , Enfermagem Familiar , Competência Profissional , Enfermagem em Saúde Pública , Adulto , Brasil , Humanos , Pessoa de Meia-IdadeRESUMO
The objective was to follow the working process of a family health team in their regular meetings held to discuss family cases. This study used a qualitative approach, founded on the theoretical and methodological framework institutional schizoanalytic analysis. Seventeen meetings were followed, which counted with the participation of an average of 7 to 8 of the 17 workers participating in the study. The team held discussions on the families, and classified them according to the risk criteria, reviewed what had been accomplished in the meting and searched for action alternatives. There were disagreements when participants faced differences and difficulties to be heard by their colleagues, which were gradually overcome, and made it possible for the members to share care situations they had in common. The team made an effort to analyze the how they take care of the families and to get them to integrate. It was concluded that the meetings favor the production of care and the construction of group work as the team, while delivering care, deals with the subjectivities produced in their practice.
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Saúde da Família , Enfermagem Familiar , Processos Grupais , HumanosRESUMO
OBJECTIVE: To identify the steps of the Nursing Process and integral care. METHOD: Document analysis study on medical and nursing consultations records during postpartum conducted in primary health units in inland São Paulo state. The analysis comprised the registered steps, the sequence of steps, and the approach of psychosocial questions. The data are presented by frequency, percentage, and the expressed content of care. RESULTS: The analyzed records amounted to 341. Out of these, 100% presented History; 62.2%, Nursing Diagnosis; 5.3%, Planning; 99.1%, Implementation; and 50.1%, Evaluation. Regarding the sequence of steps, 47.5% of the medical records presented three steps. In the incorporation of the principle of integrality, a more frequent presence of the biological approach was observed. CONCLUSION: This study shows the change of practice of nurses, with efforts to register the Nursing Process, and that the integrality of care constitutes a challenge to surpass a model of care which is fragmented and decontextualized from the life conditions of people.
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Processo de Enfermagem , Feminino , Humanos , Período Pós-Parto , Atenção Primária à Saúde , Encaminhamento e ConsultaRESUMO
This descriptive exploratory study analyzed user satisfaction with the care received at a Family Health Unit in Ribeirão Preto, Brazil. In total, 40 users from families registered in the FHU were selected, using key informants and the snowball sampling technique, and interviewed. Thematic content analysis was used to analyze the empirical material. Interviewees were mostly female, over 50 years, resident in the catchment area of the unit for 10-30 years, had incomplete primary education and also did not perform work outside the home. The analysis identified three themes: access, team-user interaction and organization of work in the FHU. The subjects of this study expressed satisfaction with the accessibility provided together with the caring attention given to them, marked by a team-user interaction that takes place in a friendly and patience manner. Although not totally satisfied, the majority of users would recommend the health service to someone due to its quality.
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Saúde da Família , Satisfação do Paciente , Atenção Primária à Saúde/normas , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: to identify and analyze possibilities for recognizing health needs in the nurses' work at Family Health Strategy. METHODS: a qualitative study with interviews and observation of the nurses' work in the countryside of São Paulo. The empirical material was subjected to thematic content analysis and interpreted in the light of the health work process. RESULTS: two themes emerged: Possibilities utilized and Possibilities neglected to recognize health needs. Careful observation, welcoming, attention, listening, bonding and dialogue developed by nurses, in live work in action with users, touched on the possibilities, which, taken advantage of, were evidenced in care in spontaneous demand, scheduled consultation, examination gynecological and group activities. FINAL CONSIDERATIONS: nurses are able to recognize health needs, which can expand their clinical practice and interprofessionality in Family Health.
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Saúde da Família , Enfermeiras e Enfermeiros , Atitude do Pessoal de Saúde , Brasil , Humanos , Pesquisa QualitativaRESUMO
This study aimed to identify and analyze aspects regarding the preparation for the worker-user relationship in a primary health care unit in a city in the state of São Paulo-Brazil, from the perspective of welcoming. The health work process is the theoretical basis of the study; participant observation and semi-structured interviews were used as data collection techniques, and thematic analysis in the analysis stage. For the welcoming to be processed, there is a 'moment' of preparation for the worker, the physical environment and the relationships present at work so that users are welcomed, in which the users' needs are sometimes disregarded. Despite the difficulties in terms of resource availability, especially in the public sector, when preparing the service/user and worker/user relationships, one should consider the aspects associated to a more human, welcoming relationship, since it is during live work, in this intersection, that care quality is established.
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Relações Interpessoais , Atenção Primária à Saúde , HumanosRESUMO
This qualitative study aimed at understanding the elements that constitute the work process in the reception room of a Primary Care Unit. The theoretical approach used was the work process in health. Data were collected through free observation and semi-structured interview. The Discourse of the Collective Subject and the Thematic Analysis were used for data organization and treatment. Results reveal fragmentation of the work process. The duties are taken as subject of the job, the needs of the users are limited to execution of procedures, and the main instruments are the norms and routines. The work purpose is care to the needy people. We concluded there is a need to develop analysis about the work.
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Instituições de Assistência Ambulatorial , Atenção Primária à Saúde , Trabalho , HumanosRESUMO
A critical reflection is proposed on the knowledge that has been produced by Nursing, that identifies it as a discipline, and on whether that knowledge is enough, based on the positive sciences and therefore with a framework of science and scientific discipline in order to build the fundamentals of care, which is the object with which Nursing works. Under a historical perspective, this paper analyzes how Brazilian Nursing, especially since the 1990s, has been dedicating itself to theoretical and practical problems and to concrete experiences on care anchored to various knowledge dimensions, signalizing the need for continuity of knowledge production that is linked to practical and routine experiences of Nursing, including other knowledge approaches that are focused on ontological, existential, dialogical and other dimensions, because the health-disease process is always complex and filled with ethical values which express the singularity of men.
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Enfermagem/normas , Brasil , Pesquisa em Enfermagem , Teoria de Enfermagem , Filosofia em EnfermagemRESUMO
OBJECTIVE: To discuss and reflect on collective health nursing practices, presenting the work-related experience of nurses. METHOD: This was a reflection paper based on the labor process theory. RESULTS: Studies conducted in research groups, discussions at scientific events, and professional experiences point to the importance of recognizing the intentionality of health work. Furthermore, it is essential t understand the health-illness-care process adopted and advocated by health professionals, and the role of social determinants and the entire historical, political, economic and social context of professional training, healthcare service organization and society. CONCLUSION: Collective health nursing practices play an important role in the health care provided to the population. Nurses are reference professionals in health care in all stages of life; however, further reflection is required on professional training, politicization, and the concepts of health and illness that guide professional practices.
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Comportamento Cooperativo , Atenção Primária à Saúde/métodos , Autogestão/métodos , Humanos , Comportamento SocialRESUMO
Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.
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Idoso Fragilizado , Fragilidade/diagnóstico , Idoso de 80 Anos ou mais , Fragilidade/mortalidade , Humanos , Inquéritos e QuestionáriosRESUMO
RESUMO: Objetivo: identificar o conhecimento dos enfermeiros e as práticas relacionadas a úlceras ou infecções em membros inferiores nas pessoas com diabetes mellitus.Método: estudo qualitativo realizado com 24 enfermeiros de equipes de saúde da família de um município do interior do estado de Minas Gerais - Brasil. Entrevistas semiestruturadas foram realizadas nos meses de outubro e novembro de 2022, analisadas pela técnica de análise temática e discutidas pela literatura relativa à temática. Resultados: foram identificadas duas categorias temáticas: "Conhecimento sobre úlceras ou infecções em membros inferiores em pessoas com diabetes mellitus" e "Trabalho do enfermeiro no cuidado às pessoas com diabetes mellitus". Conclusão: o estudo demonstrou que os conhecimentos e as práticas sobre úlceras ou infecções em membros inferiores estão fragilizados, evidenciando a necessidade de construção do conhecimento na área da enfermagem e o incentivo para a adoção de medidas preventivas pelos profissionais de saúde, em especial, os enfermeiros da atenção básica.
ABSTRACT Objective: To identify nurses' knowledge and practices related to lower limb ulcers or infections in people with diabetes mellitus. Method: A qualitative study was conducted with 24 nurses from family health teams in a municipality in the countryside of the State of Minas Gerais - Brazil. Semi-structured interviews were conducted in October and November 2022, analyzed using the thematic analysis technique, and discussed using the literature on the subject. Results: The study's findings revealed two crucial thematic categories: "Knowledge about lower limb ulcers or infections in people with diabetes mellitus" and "The work of nurses in caring for people with diabetes mellitus". These findings underscore the urgent need to improve knowledge and practices about ulcers or infections in the lower limbs, emphasizing the pivotal role of nurses in this process. Conclusion: The study showed that knowledge and practices about ulcers or infections in the lower limbs are fragile, highlighting the need to build knowledge in the nursing field and encourage the adoption of preventive measures by health professionals, especially primary care nurses.
RESUMEN: Objetivo: identificar los conocimientos y prácticas del personal de enfermería relacionados con las úlceras o infecciones de los miembros inferiores en personas con diabetes mellitus. Método: estudio cualitativo realizado con 24 enfermeros de equipos de salud familiar de un municipio del interior del estado de Minas Gerais - Brasil. En octubre y noviembre de 2022 se llevaron a cabo entrevistas semiestructuradas, que se analizaron mediante la técnica del análisis temático y se debatieron a partir de la bibliografía sobre el tema. Resultados: se identificaron dos categorías temáticas: "Conocimientos sobre úlceras o infecciones de los miembros inferiores en personas con diabetes mellitus" y "El trabajo del enfermero en el cuidado de las personas con diabetes mellitus". Conclusión: El estudio demostró que los conocimientos y las prácticas sobre las úlceras o infecciones de los miembros inferiores son frágiles, lo que pone de relieve la necesidad de aumentar los conocimientos en el campo de la enfermería y fomentar la adopción de medidas preventivas por parte de los profesionales sanitarios, especialmente los enfermeros de atención primaria.